Fall Prevention for Older Adults: Risks and What Works

Fall Prevention for Older Adults: Risks and What Works

Fall prevention for older adults works best when you combine three things: regular strength and balance exercise, a review of medicines that can make you dizzy, and a safer home. Falls are common after 65, but they are not a normal or unavoidable part of aging. Exercise alone lowers the rate of falls by about a quarter in clinical trials, and the other steps add to that.

This article is for general information and is not medical advice.

Key takeaways

  • More than one in four people aged 65 and older falls each year, and one fall roughly doubles the chance of another.
  • The biggest risk factors you can change are weak legs, poor balance, certain medicines, vision problems and home hazards.
  • Exercise programs that train balance, gait and strength, done 2 to 3 times a week for months, are the best proven way to prevent falls. Tai chi counts.
  • Simple home fixes (grab bars, better lighting, no loose rugs) matter most for people who are already at higher risk.
  • Tell your doctor about every fall or near fall, even if you were not hurt.

How common are falls in older adults?

Very common. According to the CDC's facts about older adult falls, more than one out of four people aged 65 and older falls each year, yet fewer than half tell their doctor.

The CDC also reports that about one in 10 falls causes an injury, and falls lead to about 4.5 million emergency department visits a year among older adults. About 1.4 million of those visits end in a hospital stay.

Two injuries stand out. Falls cause the large majority of hip fractures, with nearly 319,000 older people hospitalized for a hip fracture each year. Falls are also the most common cause of traumatic brain injury (an injury to the brain from a blow or jolt to the head) in older adults.

The picture is similar worldwide. The World Health Organization falls fact sheet estimates about 842,000 fall deaths globally in 2023, and about 71% of those deaths were in people aged 60 and older.

What raises your risk of falling?

Most falls have more than one cause. Weak muscles, poor balance, medicines, eyesight and the space around you usually add up, which is why fixing several small things works better than fixing one.

Muscle weakness and balance problems

Leg strength and balance are what catch you when you trip. Both decline with inactivity and age. If you have noticed you need your arms to get out of a chair, it may be worth reading about why muscle mass drops with age and how to rebuild it. The WHO lists impaired balance, strength, gait (the way you walk) and mobility as key reasons older people fall.

Medicines

Some medicines cause dizziness, drowsiness, blurry vision or a drop in blood pressure when you stand. A CDC medication fact sheet names these groups as raising fall risk:

  • Opioid pain medicines
  • Some antidepressants
  • Anti-anxiety medicines such as benzodiazepines
  • Prescription and over-the-counter sleep aids, including diphenhydramine and doxylamine
  • Muscle relaxants
  • Allergy and motion sickness medicines such as meclizine and hydroxyzine
  • Bladder control medicines
  • Antipsychotic and some mood medicines
  • Blood pressure and heart medicines

Do not stop any of these on your own. Bring a full list, including supplements, to your doctor or pharmacist and ask which ones could affect your balance.

Vision, health conditions and alcohol

Worsening eyesight makes it harder to spot steps and edges. The WHO also names neurological and heart conditions, alcohol use and unsafe stairs, lighting and walking surfaces as risk factors. Poor sleep can play a part too, since nighttime bathroom trips in the dark are a common setting for falls. If that sounds familiar, see our guide on why older adults struggle with sleep and how to improve it.

Home hazards

Loose rugs, clutter, cords, poor lighting, slippery tubs and stairs without rails are everyday tripping points. These are often the easiest risks to fix.

Which exercises actually prevent falls?

Exercise that challenges your balance and builds leg strength is the best supported way to prevent falls. The U.S. Preventive Services Task Force gives exercise a Grade B recommendation for adults 65 and older at higher risk, meaning there is good evidence of a moderate benefit.

What the evidence says

In its 2024 falls prevention recommendation, the Task Force describes the programs that worked. Most included gait, balance and functional training (practice of everyday movements like standing up and turning). Many added strength training, flexibility and endurance work. Sessions were most often 2 to 3 times a week, and programs usually lasted about 12 months, mostly as supervised group classes. Individual physical therapy also worked.

The WHO reports that exercise reduced the overall rate of falls by about 23% in trial populations, and it names tai chi as a useful option.

Types of exercise that help

TypeWhat it trainsExamplesHow often
Balance and gait trainingStaying steady when standing, turning and walkingHeel to toe walking, standing on one leg near a counter, side stepsMost days, a few minutes at a time
Strength trainingLeg and hip muscles that catch you when you tripSit to stand from a chair, step ups, calf raises, resistance bands2 to 3 times a week
Tai chiBalance, weight shifting, body awarenessSlow, flowing movement classes for beginners2 to 3 classes a week
Functional trainingEveryday movementsGetting up from the floor, carrying groceries, turning to look behind2 to 3 times a week

Tai chi is a slow, low impact practice of flowing postures that constantly shift your weight from one leg to the other, which is why it suits balance training.

For strength work, start with your own body weight. Our simple strength training plan for beginners and this beginner functional fitness routine are good starting points. Since falls are the main cause of hip fractures, it also makes sense to add safe exercises that strengthen bones.

A simple way to start

  1. Ask your doctor whether any health issue limits what you should do, then stand next to a kitchen counter you can grab.
  2. Practice standing up from a chair without using your hands, 5 to 10 times.
  3. Stand on one leg for up to 10 seconds per side, holding on lightly at first.
  4. Walk heel to toe along the counter for 10 to 20 steps.
  5. Repeat 2 to 3 days a week and add a tai chi or balance class when you can.
  6. Progress slowly: hold on less, do more reps, or add light weights over several weeks.

How can you make your home safer?

Start with lighting, floors, stairs and the bathroom, since these cause the most trips and slips. The National Institute on Aging offers a room by room guide to preventing falls at home, and the checklist below follows its advice.

Home safety checklist

  • Stairs: sturdy handrails on both sides, used every time; light switches at the top and bottom.
  • Floors: remove throw rugs and small area rugs; secure carpet edges; add non-slip strips to tile and wood.
  • Walkways: clear shoes, papers and clutter; run cords along walls; move low coffee tables out of paths.
  • Bathroom: grab bars by the toilet and inside and outside the tub or shower; non-slip mats; a night light.
  • Bedroom: a light or switch you can reach from bed; a flashlight and a charged phone at the bedside.
  • Kitchen: keep everyday items between waist and shoulder height; wipe spills right away; never stand on a chair to reach.
  • Outside: fix broken or uneven steps; keep porch lights on after dark; treat icy paths with sand or ice melt.

The WHO notes that home hazard checks cut fall rates by about 38% in higher risk older people, though not in people at low risk. So if you have already fallen or have balance problems, a home review is worth the effort. Ask your doctor about an occupational therapist visit if you want an expert look.

Footwear counts as part of your home setup. Well fitting shoes with low heels and non-slip soles are safer than slippers or socks.

What should you do after a fall?

Stay calm, check yourself for injury before moving, and only get up if you can do it slowly and without pain. If you cannot get up, call for help and keep warm while you wait.

The NHS advice on falls lays out these steps for getting up:

  1. Take your time. Do not get up too quickly.
  2. Roll onto your side, then push up onto your hands and knees.
  3. Crawl to a sturdy piece of furniture, such as a solid chair.
  4. Hold on, place one foot flat on the floor, and slowly push up to stand.
  5. Turn and sit down. Rest before you do anything else.

If you cannot get up, use your phone or a personal alarm, or shout and bang on the floor or wall. Cover yourself with anything nearby to stay warm, and gently move your arms and legs. The NHS suggests changing position about every 30 minutes to protect your skin.

This is why the NIA suggests keeping a charged phone nearby and considering a wearable alert device.

After any fall, tell your doctor even if you feel fine. The CDC notes that falling once doubles your chances of falling again, so a fall is a signal to look for causes.

Common mistakes

  • Keeping falls secret. Fewer than half of older adults tell their doctor, which means the cause never gets checked.
  • Moving less out of fear. Avoiding activity weakens muscles and raises the risk you were trying to avoid.
  • Quitting too soon. The programs that worked in studies ran for months, not weeks.
  • Stopping medicines on your own. Some need to be tapered; ask your doctor or pharmacist first.
  • Rushing to the bathroom at night in the dark. A night light and sitting on the bed edge for a moment before standing help a lot.

When to see a doctor

Call emergency services right away if, after a fall:

  • You may have hurt your head, neck, back or hip.
  • You cannot get up, or you cannot put weight on a leg.
  • The person who fell is confused, very drowsy or unconscious.

Book a regular appointment soon if:

  • You have had any fall or near fall, even without injury.
  • You feel unsteady when standing or walking, or you hold onto furniture to get around.
  • You worry about falling and have started limiting what you do.
  • You feel dizzy or lightheaded, especially after starting or changing a medicine.
  • Your eyesight has gotten worse.

Frequently asked questions

At what age should you start fall prevention?

Start building strength and balance well before 65. The research on fall prevention programs focuses on adults 65 and older, but muscle and balance habits built in your 50s carry forward. Our guide on habits that matter most after 50 covers the bigger picture.

Is tai chi better than strength training for preventing falls?

Neither is clearly better. Both appear in successful programs, and the Task Force found that most effective programs mixed balance, gait and strength work. Choose the one you will stick with, or combine them.

Does vitamin D prevent falls?

The current USPSTF falls recommendation does not cover vitamin D, and its 2018 guidance advised against taking vitamin D just to prevent falls in people living at home. Ask your doctor whether you need it for other reasons, such as low blood levels or bone health.

Should I use a cane or walker?

If you feel unsteady, a walking aid may help, but it needs to be the right type and height. Ask your doctor or a physical therapist to fit it and show you how to use it, since a poorly fitted aid can cause falls.

What to do next

  • This week, walk through your home with the checklist above and fix the two easiest items.
  • Write a full list of your medicines and supplements and ask your pharmacist which ones affect balance.
  • Try the starter routine 2 to 3 times this week.
  • At your next checkup, tell your doctor about any falls and ask for a balance check.

Sources

Last reviewed: October 2026.

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